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Just wondering if it's "necessary" to continue considering my age and slightly elevated score of 5.1. Would it be appropriate just to undergo a biopsy now and see what the results are or should I wait to see if there is a future increase in PSA?
Replies to "Just wondering if it's "necessary" to continue considering my age and slightly elevated score of 5.1...."
A biopsy wouldn't stop the tests. If they found nothing, you'd continue regular (annual) screening; if they found something mildly concerning (e.g. Gleason 3+3 or maybe 3+4), they might move you to active surveillance, which would mean PSA tests (and maybe others) every 3–6 months. If they found something serious (e.g. Gleason 4+3 or above), you'd still be getting regular PSA tests after treatment, even if you had your prostate removed.
As far as I know, the main reason to stop PSA screening or monitoring would be that you've decided not to seek treatment if they found anything, perhaps due to age, other serious health issues, or something similar. That's a very personal decision.
Trust these commenters. We all have had or are going through prostate cancer treatment. Your age and whether you want to gamble with your life over having a PSA test is strictly your decision. You don't know when the obvious cancer will kill you if you don't consult a urologist and do what he/she says. Your family might have a opinion on wanting you to do something about treatment if it turns out to be cancer. Treatment is not fun and we're all going through it because we value life and loved ones, reasons for us to stick around for a while longer.
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“Necessary” is a word-and-a-half. It’s always hard to say what’s “necessary.” The question is “What do the data indicate is appropriate to do?”
If it were me with these concerns, before jumping directly to a biopsy, (besides doing those other tests that I mentioned earlier) I would first request a 3T MRI of my prostate. Then, if the results of the MRI showed something suspicious, only then would I go to that next step of a tissue biopsy. Then, from there do whatever the data show is appropriate.
My oldest brother is going through that right now. At 78y, he had an elevated PSA (5.1, 5.5, 5.7) with no apparent reason for those increases. His 3T MRI showed two PIRADS 4 lesions; his biopsy showed those to be 3+3=6 and 4+3=7, respectively. He’s now getting more tests (PSMA PET, genetic, genomic, etc), getting referrals to specialists, and collecting more information so that he can eventually make a decision on treatment or watchful waiting.
Ultimately, it will be his call, just like yours will be your call once you have full information on your status.